21 XANTUS: A real-world, prospective, observational study of patients treated with rivaroxaban for SPAF KUDMC XANTUS is the first large, international, prospective study describing the use of rivaroxaban for stroke prevention in a broad NVAF patient population The rates of major bleeding and stroke with rivaroxaban were found to be low in routine clinical practice Over 96% patients receiving rivaroxaban did not experience any of the outcomes Treatment persistence and patient satisfaction were high 80% of patients remained on rivaroxaban 75% reported they were satisfied with their treatment at 1 year Camm AJ, et al. doi: /eurheartj/ehv466

25 ~ Our Story ~ Chief complaints: easy fatigability Present illness: This 67 year-old gentleman presented with aggravation of easy fatigability. He had been diagnosed with paroxysmal AF 7 years ago. He had been treated with amiodarone for 4 years, which was stopped because of changing to persistent AF. He had no palpitation or DOE. However, he experiences easy fatigability and poor exercise capacity recently. Past History: Hypertension: (+), Diabetes: (-), CVA (-)

31 Recommendations for Cardioversion in patients with AF 2014 AHA/ACC/HRS recommendations: Class Level AF/AFL 48 h or unknown, anticoagulation with warfarin (INR 2.0 to 3.0) is recommended for for 3 weeks before and for 4 weeks after cardioversion, regardless of the CHA2DS2-VASc score and the method AF/AFL 48 h or unknown that requires immediate cardioversion for hemodynamic instability, anticoagulation should be initiated as soon as possible and continued for at least 4 weeks after cardioversion unless contraindicated. AF/AFL < 48 h and high risk of stroke, intravenous heparin or LMWH, or administration of a factor Xa or direct thrombin inhibitor, is recommended as soon as possible before or immediately after cardioversion, followed by long-term anticoagulation therapy Following cardioversion for AF of any duration, the decision about long-term anticoagulation therapy should be based on the thromboembolic risk profile For NOACs, available data supporting similar use at cardioversion consist of subgroup analyses of RE-LY, ROCKET AF, and ARISTOTLE in patients who were receiving long-term anticoagulation (>3 weeks) around the time of cardioversion. I I I I B C C C January CT et al. J Am Coll Cardiol 2014 ;14:1740

40 ~ Our Story ~ The patient was discharged after DCCV with Amiodarone 200mg OD Xarelto 20mg OD Amlodipine 5mg OD The sinus rhythm was maintained for 6 days The patients felt the recurrence of AF with severe weakness and dizziness

41 HR: 99 BPM ~ Our Story ~ ECG 7 days after DCCV

42 ~ Our Story ~ Previous medication had been kept for 2 more months Amiodarone 200mg OD Xarelto 20mg OD with meal Amlodipine 5mg OD The patient had been weaker as time goes by. However, the surface ECG showed sinus rhythm

51 Ablation in Patients with NVAF The main clinical benefit of the procedure is an improvement in quality of life owing to elimination of the arrhythmia-related symptoms Ablation is increasingly being offered to patients with NVAF and comorbidities

53 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation KUDMC I IIa IIb III I IIa IIb III AF catheter ablation is useful for symptomatic paroxysmal AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication when a rhythm-control strategy is desired Before consideration of AF catheter ablation, assessment of the procedural risks and outcomes relevant to the individual patient is recommended

54 ~ Our Story ~ Discuss with the patient about the risks and benefits of RFCA Patient wanted to proceed the procedure Stop amiodarone 4 weeks ago Stop Xarelto 1 day ago

59 Anticoagulation should be based on CHA 2 DS 2 VASc score and risk & benefit of efficacy and safety Minimizing AF burden may be helpful to reduce the risk of stroke in NVAF Rhythm control should be tried as possible as you can considering risks and benefit

Security and efficacy of Rivaroxaban in real life in the prevention of the stroke in non valvular AF patients: presentation of the results of the international study Xantus Elisabetta Toso, MD Dipartment

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